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Three Part Question

In [medical residents] how does [heavy call schedule] affect [performance].

Clinical Scenario

You just finish a busy call night and want to go home to get some sleep, you run into your colleage who is just returned from having a few beers at the bar. He challenges you that he could perform better in his intoxicated state, that you, in your sleep deprived state.

Search Strategy

medical residents AND post-call AND alcohol AND performance limit to human and english language
(medical[All Fields] AND residents[All Fields]) AND post-call[All Fields] AND (("ethanol"[TIAB] NOT Medline[SB]) OR "ethanol"[MeSH Terms] OR ("alcohols"[TIAB] NOT Medline[SB]) OR "alcohols"[MeSH Terms] OR alcohol[Text Word]) AND performance[All Fields] AND English[lang] AND "humans"[MeSH Terms]

Search Outcome

One paper "Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion."

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Arnedt et al. September 7, 2005 USA	Pediatric residents	prospective, 2-session within-subject study, of 34 pediatric residents tested under 4 conditions: light call(LC), light call with alcohol(LCet), heavy call(HC), and heavy call with placebo(HCp)	Psycomotor vigilance task	compared with LC, reaction times were 7-10% slower in LCet, HC, and HCp	There was incomplete blinding. The order of the test conditions were not randomized ir counterbalanced. These tests of performance have not been validated against medical tasks. Response time, vigilance, and driving performance are not measures of clinical efficaccyor patient safety.
			Continuous performance test	compared with LC(27% commission errors), 40-70% more commission errors in LCet(46.5%,P<.001), HC(38.2%,P<.0010), and HCp(40.6%,P<.001);omission errors occured more often in all groups compared to LC
			Simulated driving task	lane variability was 13-27% greater in LCet, HC, and HCp, compared to LC. Speed variability was 29% greater in HCp than LCet(4.2 vs. 3.3mph,P=.01) and 34%-75% greater in LCet(p=.01), HCp(p<.001), and HC(P<.001). All groups had more "off roads" compared to LC.

Comment(s)

Although the authors acknowledge that these lab tests of performance have not been validated against medical tasks, the indirect implication is that residents working 80-90 hour weeks are at an equivalent or greater risk compared with an intoxicated physician.

Clinical Bottom Line

Studies such as this should motivate the medical community to accept new work hour restrictions, and provide adequate resources for residents who are post-call.

References

1. Arnedt Et al. Neurobehavioral Performance of Residents After Heavy Night Call vs After Alcohol Ingestion JAMA September 7, 2005-vol 294, No. 9, 1025-1032